Score the AR worklist by recovery probability, not just age.
Oldest-first triage sends your best callers to chase the accounts least likely to pay. RecoveAR reads the CARC and RARC codes on every 835 and ranks accounts by what they will actually recover, so the first hour of the day works the money that is still there.
The dashed rings break the age myth: a 121-day account can sit in Work First, and a fresh account can be Do-Not-Work. Age is one signal. The denial reason is the stronger one.
Why the reason code beats the calendar
The signal you already own, sitting on every remit
The 835 electronic remittance advice carries structured denial intelligence on every line. Most worklists sort past it and reach for the age bucket instead.
CARC + RARC. Every 835 line carries a Claim Adjustment Reason Code and often a Remittance Advice Remark Code. That pair is the denial's fingerprint.
The X12 835 adjustment group code tells you who owes the balance. CO (contractual) is often a write-off; PR (patient responsibility) reroutes, it does not appeal.
Payers must apply the CAQH CORE 360 Uniform Use of CARCs and RARCs Rule, so the same denial reads the same way across plans. That consistency is what a model can learn.
A Medicare redetermination must be filed within 120 days of the remittance advice. Miss the clock and the highest-value appeal is worth zero. Age tells you nothing about this. The code does.
Sources: X12 835 v5010 CARC / RARC code lists maintained by the Washington Publishing Company; CAQH CORE 360 “Uniform Use of Claim Adjustment Reason Codes and Remittance Advice Remark Codes (835)” Rule; CMS Medicare Claims Processing Manual, redetermination timeframe under 42 CFR 405.942.
Two ways to sort the same queue
Oldest-first is a proxy. Recoverability is the target.
Age sorting optimizes for one thing: making the aging report look younger. It has no opinion on whether the money is collectable.
Sorts by the calendar
- Sends senior callers to 150-day accounts denied CO-29 (past timely filing) that can never be recovered
- Buries a 35-day CO-197 auth denial with a live appeal window under the aging pile
- Treats a PR patient-balance line the same as a payer denial, wasting a follow-up call
- Rewards touching accounts, not closing dollars, so the write-off decision comes too late
Sorts by what will pay
- Reads the CARC / RARC pair, group code, payer, and remaining appeal window on every 835 line
- Ranks the queue high-to-low so the first hour hits the most recoverable dollars
- Flags do-not-work reasons up front, so effort never lands on a dead account
- Surfaces old-but-recoverable accounts the age sort would have deprioritized
The part nobody automates
Where the denial reason says do-not-work, not appeal
Not every denial is a fight worth having. The value of scoring is as much about the accounts it removes from the queue as the ones it moves up. Illustrative reads on common CARC / RARC patterns.
Dispositions are illustrative of how RecoveAR maps X12 835 CARC / RARC patterns; the actual read is tuned to each payer contract and the CO / PR / OA / PI group code on the line. Codes and definitions per the Washington Publishing Company CARC and RARC lists.
The clock the age bucket ignores
Every appealable denial has an expiry date
A recoverability score has to be time-aware. A denial worth $4,000 with three days of appeal window left outranks a $6,000 denial with ninety. Real Medicare appeal windows below.
Redetermination
From receipt of the remittance advice (MAC level).
Reconsideration
From the redetermination notice (Qualified Independent Contractor).
ALJ hearing
From the reconsideration decision, above the amount-in-controversy threshold.
Commercial payers
Plan-specific appeal windows, often 90 to 180 days per the provider manual. Scored per payer.
Sources: CMS Medicare Parts A & B appeals process, five levels under 42 CFR Part 405 Subpart I; commercial timelines per individual payer provider manuals. RecoveAR ingests each payer's window so the score decays as the deadline approaches.
Under the hood
From 835 to a ranked worklist, every morning
No new data entry. RecoveAR works from the remits you already receive.
Read the 835
Pull CARC, RARC, group code, payer, balance, and dates from every remit line.
Predict recovery
Model the denial pattern, payer behavior, dollar size, and remaining appeal window.
Order the queue
High-to-low recoverability, with do-not-work and reroute lines pulled out.
Best dollars first
Your team starts the day on the accounts most likely to pay, before the clock runs.
Stop paying senior-caller time to chase dead accounts.
Send us a week of 835s and we will show you the same queue two ways: your current age sort, and the RecoveAR probability score. You will see exactly which accounts move up, which drop out, and how many appeal windows were about to close unnoticed.
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